Graddy, Marvin Darnell

Graddy, Marvin Darnell is an sole proprietor health care provider with primary practice located at 1320 Rockspring Way , Antioch CA 94531-8397. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Mental Health. Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) is his primary health care specialty. Graddy, Marvin Darnell can be contacted via phone (925) 334-9906.

Contact Information

Primary practice address
1320 Rockspring Way Antioch CA 94531-8397
Phone: (925) 334-9906
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X 101YA0400X California
Behavioral Health & Social Service Providers / Mental Health 101YM0800X 101YA0400X California
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 103TA0400X 101YA0400X California

Profile Details

NPI number 1144805011
LBN Legal business name Graddy, Marvin Darnell
Credentials
Entity Individual
Sole proprietor 1 Yes
Enumeration date Mar 12th, 2021
Last updated Mar 12th, 2021 - about 3 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1144805011 NPPES
California MEDICAID 5VE8-FC6-UP53

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